Does the high performance athlete need hormone replacement?
L. Di Luigi
Endogenous hormones (e.g. catecholamines, glucocorticoids, growth hormones, androgens, growth factors) may affect the characteristics of physical capacity and performance in athletes by influencing, throughout long-term and short term effects, morphological and functional qualities of neuromuscular, cardiovascular, metabolic and adaptive systems. Exercise per se is associated to the release of different hormones: acute exercise stimulates an acute hormones secretion (e.g. catecholamines, growth hormone, CRH-ACTH-cortisol, testosterone) while chronic exercise (training) is able to modify hormones secretion at rest and their activation during acute exercise. A physiological quantitative/qualitative hormone release at rest (e.g. for long-term effects) and an adequate hormones activation during exercise (e.g. for short-term effects) are essential to reduce specific health risks and to guarantee optimal performances in athletes. Consequently, in athletes with reduced/altered hormonal secretion a correct and specifically adapted replacement therapy is necessary. In fact, at least in theory, for health-protective concerns and to guarantee optimal/maximal physiological performances the hormone replacement in athletes should assure the physiological amount of the reduced hormone and to reproduce, as much as possible, its physiological profile/rhythm and specific activation during exercise. In this sense, besides symptomatic classical diseases or conditions that may reduce/alter the qualitative/quantitative hormones secretion, serious clinical concerns exist for asymptomatic endocrine hypo-function (e.g. sub-clinical hypogonadism, growth hormone deficit and hypothyroidism), particularly in adult athletes. For example, in master athletes we observed an high prevalence of undiagnosed severe (12%) and mild (18%) hypo-testosteronemia frequently in the absence of clinical symptoms. In our opinion, a testosterone replacement therapy should be considered in all athletes with true hypogonadism (e.g. no related to anabolic androgens abuse) independently from the presence of classic symptoms of hypogonadism and if no contraindications exist. Unfortunately, few studies evaluated the prevalence of reduced hormones secretion in athletes and the concept of adapted hormone replacement in high competitive athletes.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.